Provider Demographics
NPI:1497898662
Name:OSO, KAY OLUKAYODE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:OLUKAYODE
Last Name:OSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 N PEACHTREE PKWY STE 376
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4210
Mailing Address - Country:US
Mailing Address - Phone:404-691-6688
Mailing Address - Fax:
Practice Address - Street 1:3890 REDWINE RD SW
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5582
Practice Address - Country:US
Practice Address - Phone:404-691-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA44049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG68297Medicare UPIN
GA11BDWFTMedicare PIN